Willan B D, McGowan D G
Int J Radiat Oncol Biol Phys. 1985 Oct;11(10):1769-75. doi: 10.1016/0360-3016(85)90030-6.
An analysis is presented of 188 patients with a histological diagnosis of seminoma testis, treated by radical orchiectomy and radiation therapy between 1960 and 1981 at the Cross Cancer Institute. Using the Walter Reed Hospital staging classification, 149 (79%) patients were Stage I, 34 (18%) were Stage II, and 5 (3%) were Stage III. The 5-year survival for all stages was 90%, and for Stage I was 98%, Stage II, 71%, and Stage III, 0%. All were treated primarily with radiation therapy. Prophylactic mediastinal radiation was not employed for Stage I, and was employed in half of Stage II patients. Eleven patients with Stage I relapsed, five in the mediastinum and/or neck nodes. Eight of 11 were cured with further treatment. Stage II patients were subdivided according to the presence or absence of a palpable abdominal mass. Palpable disease (Stage IIB) carried a poorer prognosis. Three of 20 patients without a palpable mass (Stage IIA) died of disease; there was an 82% five-year survival rate. Eight of 14 with a palpable mass (Stage IIB) were cured by radiotherapy; there was a 54% five-year survival rate. All five Stage III patients died within 1 year of diagnosis. Stage I and IIA seminoma is curable by radiation alone. Prophylactic mediastinal radiation is not indicated in either Stage I or IIA disease. Long term toxicity from radiation is not seen. Optimal treatment for Stage IIB disease is undetermined and new treatment regimens should be explored. Stage III disease requires primary chemotherapy.
本文分析了1960年至1981年间在十字癌症研究所接受根治性睾丸切除术和放射治疗的188例组织学诊断为睾丸精原细胞瘤的患者。采用沃尔特·里德医院分期分类法，149例（79%）患者为I期，34例（18%）为II期，5例（3%）为III期。所有分期的5年生存率为90%，I期为98%，II期为71%，III期为0%。所有患者均主要接受放射治疗。I期患者未采用预防性纵隔放疗，II期患者中有一半采用了预防性纵隔放疗。11例I期患者复发，5例为纵隔和/或颈部淋巴结复发。11例中有8例经进一步治疗治愈。II期患者根据是否可触及腹部肿块进行细分。可触及病变（IIB期）预后较差。20例无可触及肿块的患者（IIA期）中有3例死于该病；5年生存率为82%。14例可触及肿块的患者（IIB期）中有8例通过放疗治愈；5年生存率为54%。所有5例III期患者均在诊断后1年内死亡。I期和IIA期精原细胞瘤仅通过放疗即可治愈。I期或IIA期疾病均无需进行预防性纵隔放疗。未观察到放疗的长期毒性。IIB期疾病的最佳治疗方法尚未确定，应探索新的治疗方案。III期疾病需要进行原发性化疗。
